Helping Babies Breathe: A Global Curriculum for Neonatal Resuscitation in Resource Limited Environments

Friday, October 16, 2009
145 (Washington Convention Center)
George A. Little, MD, FAAP, Department of Pediatrics, Dartmouth Medical School, Lebanon, NH, William J. Keenan, MD, FAAP, Dept of Pediatrics, St Louis University, St Louis, MO, Susan Niermeyer, MD, FAAP, Dept of Pediatrics, University of Colorado Denver, Aurora, CO, Nalini Singhal, MD, FAAP, Dept of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada and Eileen Schoen, Life Support Programs, American Academy of Pediatrics, Elk Grove Village


Birth asphyxia accounts for 23% of the world's 4 million yearly neonatal deaths. Depressed babies comprise a substantial portion of the estimated 3.2 million stillbirths.  Helping Babies Breathe (HBB) is an educational program designed to equip birth attendants with knowledge and skills to provide neonatal resuscitation in resource-limited settings.  


Program design and curriculum were developed by international experts and collaborating organizations utilizing ILCOR (International Liaison Committee on Resuscitation) evidence-based neonatal resuscitation guidelines.  The curriculum was integrated into an educational program following input from teaching experts and a Delphi survey that addressed content, feasibility and generalized applicability. Community resources and the need for effective, low-cost graphic material sensitive to culture and amenable to translation were primary considerations.

The  AAP is the partnership convener with primary partners being the WHO and NICHD.  Collaborators include USAID, Save the Children/ Saving Newborn Lives.  Funding has been provided by the Laerdal Foundation for Acute Medicine and the Latter Day Saints Charities   


Outcomes to date include an evidence-based global neonatal resuscitation curriculum and learner/facilitator materials. A pictoral algorithm (action plan) is an important focus. Content emphasizes skilled assessment at birth, stimulation to breathe and assisted ventilation for all newborns with poor breathing within one minute (the Golden Minute (SM)).  Educational principles include active, case-based learning with low-cost mannequin-based skills practice,  language appropriate for education level and translation, and graphic concept presentation.  

A key outcome is agreement  that HBB technical and educational content is appropriate and can be integrated into comprehensive training material and clinical programs directed at millennium development goal (MDG) 4. Materials are undergoing educational field testing in Pakistan and Kenya. Recognized challenges include the reality that program implementation and evaluation will continue to rely upon involvement and collaboration of interest groups, national and international governmental bodies, academic centers and private organizations. 

Conclusions: An internationally harmonized, evidence-based educational program for neonatal resuscitation in resource limited environments, Helping Babies Breathe, has successfully incorporated formative evaluation through expert workgroups, Delphi survey and inter-organizational collaboration.  Such an approach offers advantages for educational program development in other efforts aimed at achieving millennium development goals.